Provider Demographics
NPI:1871640524
Name:HERBENER-NEUKOM, LYNNE ANN (MA, ATC)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:ANN
Last Name:HERBENER-NEUKOM
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 S HILLSDALE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-9820
Mailing Address - Country:US
Mailing Address - Phone:517-439-5176
Mailing Address - Fax:
Practice Address - Street 1:1440 S HILLSDALE RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-9820
Practice Address - Country:US
Practice Address - Phone:517-439-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer